Billing code 63197: CordotomyMedicare rate & RVUs in Illinois
Report this service when a surgeon uses a thoracic laminectomy to expose the spinal cord and perform a cordotomy, commonly to interrupt severe pain signaling.
CMS doesn’t publish an office rate for 63197 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 63197 covers
The surgeon removes part of the posterior thoracic vertebral arch to reach the spinal cord, then interrupts a selected cord pathway. Neurosurgeons may perform this operation for carefully selected patients with severe, persistent pain, including pain associated with advanced cancer. The operative report should identify the thoracic approach and document the cordotomy performed; a laminectomy alone or a procedure directed at spinal nerve roots is a different service.
Select this code for the thoracic laminectomy-with-cordotomy service, whether performed in one or more stages. The descriptor does not support reporting additional units solely for multiple stages. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this descriptor. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 63197 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $2,121.15 |
| East St. Louis | Unavailable | $1,974.26 |
| Rest Of Illinois | Unavailable | $1,820.85 |
| Suburban Chicago | Unavailable | $1,960.36 |
How the 63197 rate is calculated
Each of 63197’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 63197
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.48Practice expense 17.01Malpractice 9.92
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 63197
63197 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63197
Cordotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 63197
Cordotomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
63197 without 51 · national facility
$1,683.74
Cordotomy
63197-51 · Second procedure: 50%
$841.87
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
63197 compared with similar codes
Compare codes
63197 vs 63170 vs 63185: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 63170Spinal cord surgery
- This code describes thoracic laminectomy with cordotomy. Compare the operative service with 63170's spinal cord tract incision descriptor rather than selecting by the word cordotomy alone.
- 63185Spinal rhizotomy
- 63185 concerns spinal nerve-root sectioning. This code is for cordotomy performed through a thoracic laminectomy, so the neural target distinguishes them.
63197 billing questions
When should this code be selected instead of a spinal nerve-root section code?
Use this code when the surgeon performs a thoracic laminectomy and interrupts a spinal cord pathway. Codes for spinal nerve-root sectioning describe work directed at nerve roots, not the cord.
Does the code include the thoracic laminectomy exposure?
Yes. The laminectomy is the approach used to expose the cord for the cordotomy; do not separately report that exposure as a standalone laminectomy service.
Should modifier 50 be appended for a bilateral procedure?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor.
How should multiple stages affect units?
The descriptor covers one or more stages. Do not report extra units solely because the operation is staged.
What documentation supports reporting this code?
The operative report should establish the thoracic laminectomy approach and the cordotomy performed, including the operative site and the cord pathway work.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 63197 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →